Daetwiler S, Guller U, Schob O, Adamina M
Department of Surgery, Spital Limmattal, Schlieren, Switzerland.
Br J Surg. 2007 May;94(5):634-41. doi: 10.1002/bjs.5638.
Laparoscopic sigmoid colectomy for benign diseases is becoming the standard of care. However, few residency programmes incorporate the procedure. This study evaluated the safety and feasibility of the early introduction of laparoscopic sigmoid colectomy during residency.
From a database of consecutive laparoscopic sigmoid colectomies collected prospectively over 6 years, those for cancer and primary open sigmoid colectomies were excluded. Surgeons were categorized into five levels of experience in colonic surgery. Patient demographics, operative data, complications and conversion rates were assessed.
A total of 262 sigmoid colectomies were performed by 13 surgeons. American Society of Anesthesiologists grade and diverticular disease classification were similar across the five experience levels. There were no significant differences in morbidity, mortality or readmission rates between experience levels. However, operative time (230 versus 145 min, P < 0.001) intraoperative blood loss (200 versus 100 ml, P < 0.001) and conversion rate (13.6 versus 2.1 per cent, P = 0.002) all decreased with increasing surgical experience (trainee versus trainer).
It is safe and feasible to introduce laparoscopic sigmoid colectomy to a structured residency.
腹腔镜乙状结肠切除术治疗良性疾病正逐渐成为标准治疗方法。然而，很少有住院医师培训项目纳入该手术。本研究评估了在住院医师培训期间早期引入腹腔镜乙状结肠切除术的安全性和可行性。
从一个前瞻性收集的连续6年的腹腔镜乙状结肠切除术数据库中，排除癌症手术和原发性开放性乙状结肠切除术。将外科医生按照结肠手术经验分为五个级别。评估患者人口统计学、手术数据、并发症和中转率。
13名外科医生共进行了262例乙状结肠切除术。美国麻醉医师协会分级和憩室病分类在五个经验级别中相似。经验级别之间的发病率、死亡率或再入院率无显著差异。然而，随着手术经验增加（住院医师与带教医师相比），手术时间（230对145分钟，P<0.001）、术中失血量（200对100毫升，P<0.001）和中转率（13.6%对2.1%，P=0.002）均降低。
将腹腔镜乙状结肠切除术引入结构化住院医师培训是安全可行的。
